Revenue Cycle Collections Specialist

Revenue Cycle Collections Specialist

Department: Revenue Cycle Management (RCM) Reports To: Revenue Cycle Manager Employment Classification: Full-Time | Non-Exempt Location: Johnson City, TN (on-site)

Position Summary

The Revenue Cycle Collections Specialist is responsible for the proactive management, follow-up, and resolution of outstanding insurance accounts receivable to maximize reimbursement and minimize aging balances.

This position is accountable for researching unpaid, underpaid, and denied claims; engaging insurance payers to secure appropriate reimbursement; and resolving outstanding balances in a timely manner.

The ideal candidate demonstrates strong analytical skills, persistence, payer reimbursement knowledge, and a high degree of ownership over assigned accounts receivable.

Essential Duties and Responsibilities

Accounts Receivable Management

• Manage an assigned portfolio of insurance accounts receivable, prioritizing claims based on age, balance, payer, and reimbursement risk.

• Perform timely follow-up on unpaid, delayed, denied, and underpaid claims.

• Contact insurance payers through portals, telephone, and other approved communication channels to determine claim status and facilitate resolution.

• Investigate outstanding balances and identify root causes of payment delays.

• Resolve outstanding claims through appropriate follow-up, corrected claims, reconsiderations, appeals, or other authorized processes.

• Ensure claims are addressed before applicable timely filing and appeal deadlines.

• Maintain accurate account notes documenting actions, payer communications, and next steps.

Denial Management and Appeals

• Analyze claim denials to identify underlying causes and appropriate corrective actions.

• Prepare and submit appeals, reconsiderations, and supporting documentation.

• Identify patterns in payer denials, payment discrepancies, and reimbursement practices.

• Collaborate with billing specialists and clinical personnel to correct recurring claim issues.

• Escalate systemic payer issues, contractual disputes, and unresolved claims to RCM leadership.

Payment Integrity and Reimbursement

• Review insurance payments for accuracy against applicable contractual allowances and expected reimbursement.

• Identify and pursue underpayments and inappropriate claim adjustments.

• Research payment discrepancies, coordination-of-benefits issues, and outstanding payer obligations.

• Recommend account adjustments or write-offs when appropriate, subject to established authorization policies.

• Assist in reconciling outstanding claims and ensuring accurate A/R reporting.

A/R Aging and Performance Management

• Work assigned accounts consistently according to established aging and prioritization protocols.

• Focus on reducing balances aged beyond 60 and 90 days.

• Identify claims at risk of becoming uncollectible and escalate promptly.

• Maintain a documented follow-up plan for unresolved accounts.

• Provide feedback regarding payer trends, operational barriers, and opportunities to accelerate reimbursement.

• Participate in periodic A/R reviews and performance improvement initiatives.

Required Qualifications

• High school diploma or equivalent required; associate degree preferred.

• Minimum 2 years of medical insurance collections, accounts receivable, or denial management experience preferred.

• Strong understanding of Medicare, Medicaid, and commercial insurance reimbursement.

• Experience with claim status research, denial resolution, appeals, and payer follow-up.

• Working knowledge of CPT, ICD-10-CM, insurance terminology, and explanation of benefits (EOB) documentation.

• Proficiency with EHR/practice management systems, payer portals, and Microsoft Excel.

• Strong communication, negotiation, organizational, and problem-solving skills.

Preferred Qualifications

• Experience with Athenahealth or comparable practice management platforms.

• Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), or similar credential.

• Experience managing complex or aged insurance receivables.

• Familiarity with payer contracts, fee schedules, and reimbursement variance analysis.

• Experience in a multispecialty or multi-location physician practice.

Performance Expectations

The Collections Specialist is expected to demonstrate active ownership of assigned accounts receivable, maintain disciplined follow-up practices, and pursue timely and appropriate reimbursement.

Success in this position is measured by documented account activity, effective claim resolution, reimbursement recovery, reduction in aged receivables, and the prevention of avoidable revenue loss.

The specialist is expected to identify barriers proactively, escalate unresolved issues appropriately, and contribute to continuous improvement in revenue cycle performance. /c

Benefits:

Medical, Vision, Dental, PTO, 401K, and Weekends Off!